自体血小板分离回输与异体血小板输注在急性A型主动脉夹层手术中的有效性比较

Efficiency of Autologous Plateletpheresis Transfusion and Allogeneic Apheresis Alatelet Transfusion in TAAD

目的比较自体血小板分离回输与异体血小板输注对急性A型主动脉夹层手术的血液保护作用和短期转归的影响。方法回顾性分析2019年6月—2021年12月在我院行急性A型主动脉夹层手术患者78例,其中自体血小板分离(APP)组40例,术中接受自体血小板分离回输;对照组38例,术中接受1治疗量异体单采血小板输注。记录两组患者术前等待时间、术中出血量、术后胸导管引流量、术中、围术期及住院期间异体血输注量、术后机械通气时间、ICU监护时间、住院时间和围术期并发症发生率及院内死亡率,并分析两组之间差异。结果APP组术前等待时间显著短于对照组(Z=–2.48,P<0.05),术后机械通气时间显著短于对照组(Z=–2.20,P<0.05),术后肺部感染率为17.5%,显著低于对照组39.5%(χ^(2)=4.65,P<0.05),术中和围术期红细胞、血浆和冷沉淀输注量均显著低于对照组(P<0.05),差异有统计学意义。两组术中出血量、住院期间输血量、ICU监护时间、住院时间和院内死亡率无显著差异。结论与异体血小板输注相比,自体血小板分离回输有效减少术前等待时间和机械通气时间,降低术后肺部感染率和围术期异体血输注量,有更好的血液保护效果,但对患者短期预后无明显改善作用。

Objective To compare the efficiency of autologous plateletpheresis(APP)transfusion and allogeneic apheresis platelet transfusion on the blood protection and the short-term outcome of type A aortic dissection(TAAD).Methods A retrospective review was performed of 78 patients who underwent TAAD operation in our hospital between June 2019 and December 2021.Of which 40 patients received APP transfusion and 38 patients in the control group received 1U of allogeneic apheresis platelet transfusion.The preoperative waiting time,intraoperative blood loss,output from postoperative chest tube,perioperative blood transfusion,ventilation time,length of stay(LOS)in the intensive care unit(ICU),hospital stay,and the incidence of perioperative complications and in-hospital mortality between the two groups were analyzed.Results The preoperative waiting time in APP group was significantly shorter than that in the control group(Z=-2.48,P<0.05).The ventilation time was shorter,too.(Z=-2.20,P<0.05).Postoperative pulmonary infection rate was 17.5%,significantly lower than that in the control group(χ^(2)=4.65,P<0.05).The intraoperative and perioperative transfusion of red blood,plasma and cryoprecipitate were significantly lower than those in the control group(P<0.05).There were no significant differences between the two groups in intraoperative blood loss,ICU LOS,hospital stay and in-hospital mortality.Conclusion Compared with allogeneic platelet transfusion,APP transfusion can effectively reduce the preoperative waiting time,mechanical ventilation time,postoperative pulmonary infection rate and perioperative allogeneic blood transfusion use,so as to better blood protection effect,but it has no significant improvement on the short-term outcome of patients.